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Cited by 372Lung Cancer Diagnosis and TreatmentLung Cancer Research StudiesLung Cancer Treatments and Mutations

Special Treatment Issues in Non-small Cell Lung Cancer

Kozower, Benjamin D., Larner, James M., Detterbeck, Frank C., Jones, David R.·2013·Chest
DOI 10.1378/chest.12-2362
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Abstract

Background This guideline updates the second edition and addresses patients with particular forms of non-small cell lung cancer that require special considerations, including Pancoast tumors, T4 N0,1 M0 tumors, additional nodules in the same lobe (T3), ipsilateral different lobe (T4) or contralateral lung (M1a), synchronous and metachronous second primary lung cancers, solitary brain and adrenal metastases, and chest wall involvement.Methods The nature of these special clinical cases is such that in most cases, meta-analyses or large prospective studies of patients are not available. To ensure that these guidelines were supported by the most current data available, publications appropriate to the topics covered in this article were obtained by performing a literature search of the MEDLINE computerized database. Where possible, we also reference other consensus opinion statements. Recommendations were developed by the writing committee, graded by a standardized method, and reviewed by all members of the Lung Cancer Guidelines panel prior to approval by the Thoracic Oncology NetWork, Guidelines Oversight Committee, and the Board of Regents of the American College of Chest Physicians.Results In patients with a Pancoast tumor, a multimodality approach appears to be optimal, involving chemoradiotherapy and surgical resection, provided that appropriate staging has been carried out. Carefully selected patients with central T4 tumors that do not have mediastinal node involvement are uncommon, but surgical resection appears to be beneficial as part of their treatment rather than definitive chemoradiotherapy alone. Patients with lung cancer and an additional malignant nodule are difficult to categorize, and the current stage classification rules are ambiguous. Such patients should be evaluated by an experienced multidisciplinary team to determine whether the additional lesion represents a second primary lung cancer or an additional tumor nodule corresponding to the dominant cancer. Highly selected patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit from resection or stereotactic radiosurgery. This is particularly true in patients with a long disease-free interval. Finally, in patients with chest wall involvement, provided that the tumor can be completely resected and N2 nodal disease is absent, primary surgical resection should be considered.Conclusions Carefully selected patients with more uncommon presentations of lung cancer may benefit from an aggressive surgical approach.

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Authors
Kozower, B. D., Larner, J. M., Detterbeck, F. C., & Jones, D. R.
Affiliations
  • University of Virginia (US)
  • Yale University (US)
Corresponding author
Jones, David R.
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2013-05
Volume
143
Issue
5
Pages
e369S-e399S
ISSN
0012-3692 (ISSN-L)
DOI
10.1378/chest.12-2362
OpenAlex
W2584148894
Cited by
372
References
254
Citations by year
2026: 17 · 2025: 31 · 2024: 30 · 2023: 24 · 2022: 27 · 2021: 41 · 2020: 32 · 2019: 17 · 2018: 30 · 2017: 36 · 2016: 30 · 2015: 26 · 2014: 25 · 2013: 6
FWCI
23.44
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • CHEST Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Keywords
non-small cell lung cancer, Pancoast tumor, solitary brain metastasis, adrenal metastasis, chest wall involvement, chemoradiotherapy, surgical resection, stereotactic radiosurgery, multimodal therapy, stage classification
MeSH terms
Brain Neoplasms, Carcinoma, Non-Small-Cell Lung, Diagnostic Imaging, Humans, Lung Neoplasms, Lymphatic Metastasis, Neoplasm Invasiveness, Neoplasm Metastasis, Neoplasm Staging, Pancoast Syndrome, Pneumonectomy, Thoracic Neoplasms, Patient Selection, Chemoradiotherapy, Neoplasm Grading

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